JPH07265329A - Puncture high frequency treatment device - Google Patents

Abstract

PURPOSE:To certainly apply high frequency treatment such as high frequency coagulation or high frequency incision to the affected part in the body by installing a high frequency electrode to the puncture member inserted in a guide tube in a slidable manner and having a puncture needle thrust in the body attached to the leading end thereof at the region thrust in the body. CONSTITUTION:A puncture treatment device 20 is constituted so as to insert a puncture member 22 in a guide tube 21 and the puncture member 22 has a puncture needle part 22b attached to the leading end of the flexible shaft part 22a thereof and a grip part 22c is attached to the base end part of the puncture member 22. The puncture member 22 is constituted of a resin material having electric insulating properties as a whole but the pointed tip part of the puncture needle part 22a is formed from a conductive member to become a high frequency electrode 23. The guide tube 21 is brought into contact with the inner wall of the body to thrust the puncture member 22 in the body 22 up to the affected part and the affected part is coagulated or incised by the action of Joule heat generated by applying a high frequency current to the high frequency electrode.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a puncture high-frequency treatment instrument which is inserted into a patient's body and pierces the inside of a body wall to perform high-frequency treatment.

[0002]

2. Description of the Related Art For example, an ultrasonic endoscope is used to perform an inspection or diagnosis after being inserted into the body and to perform an appropriate treatment based on the result of the inspection or diagnosis. This ultrasonic endoscope has a structure in which an ultrasonic observation means and an endoscope observation means are provided at the tip of an insertion portion inserted into a body cavity. The endoscopic observation means can inspect the state of the inner wall of the body cavity, and the ultrasonic observation means can inspect the tissue state in the body. In these examinations, when a diseased part or the like is found, a treatment tool is inserted and appropriate treatment is performed, but in order to allow the treatment tool to be inserted, a treatment tool insertion passage is provided in the insertion portion. . As the treatment instrument inserted through the treatment instrument insertion passage, there is a puncture treatment instrument configured to be inserted into the body to perform a predetermined treatment in addition to the treatment instrument operated in the body cavity. As a typical treatment instrument operated in the body cavity, forceps, a high-frequency treatment instrument, etc. are used to collect tissue cells on the inner wall of the body cavity or to coagulate or bleed the bleeding site.
There are things that stop bleeding. On the other hand, as a puncture treatment tool that is inserted into the body through the inner wall of the body cavity, a puncture treatment tool that is configured to inject a medical solution or the like or perform suction is conventionally known.

[0003]

By the way, for example, when there is an affected part such as cancer cells in the body, it is impossible to perform treatment using a high-frequency treatment instrument as a treatment instrument used in a body cavity. In the puncture treatment device according to the conventional technique, it is possible to inject a medical solution or remove the affected part by suction, but other than this, for example, high frequency treatment cannot be performed, etc. There is a limit to what can be done with.

The present invention has been made in view of the above points, and an object of the present invention is to reliably perform high-frequency treatment such as high-frequency coagulation or high-frequency incision on an affected area in the body. Is to

[0005]

In order to achieve the above-mentioned object, the puncture high-frequency treatment instrument of the present invention is provided with a puncture needle that is slidably inserted in a guide tube and is inserted into the body at the tip. The puncture member is characterized in that a high-frequency electrode is provided at a portion to be inserted into the body.

[0006]

For example, an ultrasonic endoscope or the like is used as the guide means, the puncture member is pulled into the guide tube, and the puncture treatment instrument is guided into the body cavity through the treatment instrument insertion channel of the endoscope. Then, when the puncture treatment tool is led out to the site to be treated and the tip of the guide tube is brought into contact with the inner wall of the body cavity and the puncture member is projected, the puncture member is inserted into the body. . When the puncture needle is inserted into a predetermined site, the site of the high frequency electrode comes to face the affected area. Therefore, by applying a high-frequency current to the high-frequency electrode, it is possible to perform high-frequency treatment such as so-called high-frequency incision by coagulating the affected area with high frequency or evaporating the tissue.

[0007]

Embodiments of the present invention will be described below with reference to the drawings. In this embodiment, the puncture treatment tool is configured to be inserted into the body via the ultrasonic endoscope. However, as the guide means for inserting the puncture treatment tool, It is not limited to an endoscope.

FIG. 1 shows the overall structure of the ultrasonic endoscope. In the figure, reference numeral 1 denotes a main body operation section of an ultrasonic endoscope, and an insertion section 2 for inserting into a body cavity is connected to the main body operation section 1. The insertion portion 2 is a flexible portion 2a for the most part from the connecting side to the main body operation portion 1, and the flexible portion 2a
The angle portion 2b is connected to the angle portion 2b, and the tip end hard portion 2c is connected to the angle portion 2b.

2 and 3 show the structure of the hard tip portion 2c. The tip end hard portion 2c is provided with an endoscope observation means and an ultrasonic observation means. The endoscope observation means is composed of an illumination window 3 and an observation window 4 provided on the tip surface of the tip rigid portion 2c. As is well known, an illumination lens is attached to the illumination window 3 and the emission end of the light guide faces it. An objective lens is attached to the observation window 4,
An incident end of a solid-state image sensor or an image guide is provided at the image forming position of this objective lens. Tip hard part 2c
In addition to these, an air / water supply nozzle 5 for cleaning the observation window 4 is provided on the tip surface of the, and a treatment instrument insertion channel 6 for inserting a treatment instrument such as forceps is opened. There is.

As the ultrasonic observation means, the tip hard portion 2c is used.
The ultrasonic transducer 7 provided on the side surface of the
Circumferential grooves 8a and 8b are formed in the front and rear portions of the ultrasonic transducer 7, and these grooves 8a and 8b are formed.
A balloon 9 is attached to a portion between b. And
A supply path 10 for supplying the ultrasonic transmission medium is opened at a position inside the groove 8b in the mounting portion of the balloon 9. Further, a puncture treatment instrument insertion passage 11 is provided at a position outside the groove 8b. The puncture treatment instrument has this puncture treatment instrument insertion passage 11
It can be inserted into the body through.

Here, the treatment instrument inserted through the treatment instrument insertion channel 6 is operated while being confirmed by the endoscope observing means. For this reason, the treatment instrument insertion channel 6 has a hard tip. An opening is formed in the distal end surface of the portion 2c, and when the treatment tool is led out into the body, it is within the visual field range of the endoscope observation means. On the other hand, the puncture treatment tool is inserted into the body, and its operation is performed by using the ultrasonic observation means as a clue. Therefore, the puncture treatment instrument insertion path 11 through which the puncture treatment instrument is inserted is located in the observation visual field direction of the ultrasonic transducer 7 from the proximal end side of the ultrasonic transducer 7 so that the puncture treatment instrument insertion path 11 is in the ultrasonic observation visual field of the ultrasonic transducer 7. It can be made to project toward. Then, the treatment instrument insertion channel 6 and the puncture treatment instrument insertion passage 11 are provided.
Extends to the main body operating section 1, and the treatment instrument introducing section 12 and the puncture treatment instrument introducing section 1 provided in the main body operating section 1
Connected to 3.

Therefore, FIGS. 4 to 12 show an embodiment of a puncture treatment tool. First, FIGS. 4 to 6 show a first embodiment of the present invention. In the drawings, 20 is a puncture treatment instrument, and the puncture treatment instrument 20 is a flexible resin having electrical insulation properties. The guide tube 21 is made of a material and is open at both ends. The puncture member 22 is inserted into the guide tube 21. In this puncture member 22, a puncture needle portion 22b is continuously provided at the tip of a flexible shaft portion 22a having flexibility, and a grip portion 22c is provided at the base end portion. The puncture member 22 is also entirely made of an electrically insulating resin material, but the sharp tip of the puncture needle portion 22a is made of a conductive member and serves as a high frequency electrode 23.

The puncture member 22 is normally held in a retracted position drawn into the guide tube 21, and is pushed a predetermined length from the tip of the guide tube 21 by pushing the gripping portion 22c with a finger or the like. It is designed to be displaced to the operating position. And the puncture member 2
In the state where 2 is in the retracted position, the metal ring 21a is inserted and fixed to the tip of the guide tube 21 so as to surround the high frequency electrode 23 provided at the tip.

A cable 24 is connected to the high-frequency electrode 23. The cable 24 is inserted into the flexible shaft portion 22a and is connected to a contact pin 25 provided on a connecting portion 22d provided on the front side of the grip portion 22c. It is connected. Connection part 22d
Is a cylindrical member extending in a direction orthogonal to the axis of the flexible shaft portion 22a, and the contact pin 25 is arranged so as to be surrounded by the connecting portion 22d. Contact pin 2
Reference numeral 5 is a rod-shaped member having a split spring characteristic, and its tip is a spherical portion 25a.

In FIG. 5, reference numeral 26 is a high frequency power source,
A cord 27 is connected to the high frequency power source 26,
The tip of the cord 27 serves as a connector 28.
The connector 28 is formed by mounting a connector pin 30 which is detachably connected to the contact pin 25 in an electrically insulating cover cylinder 29, and the connector pin 30 is formed in a cylindrical shape. A protrusion 30a for locking is provided on the inner surface. Therefore, when the cover cylinder 29 of the connector 28 is fitted into the connecting portion 22d, the connector pin 30 is fitted into the contact pin 25 so that they are electrically connected. A patient side plate 31 is connected to the high frequency power supply 26.

This embodiment is constructed as described above, and as shown in FIG. 6, the patient side plate 31 is brought into contact with the patient P, and the ultrasonic endoscope is inserted. Part 2
Is inserted into the body from the oral cavity or the like of the patient P, and the distal end hard portion 2c is guided to a site such as the stomach where a predetermined inspection / diagnosis is to be performed. Then, the state of the inner wall of the stomach is inspected by the endoscope observing means, and the ultrasonic transducer 7 constituting the ultrasonic observing means is operated as necessary to obtain information on the state of the body tissue at a predetermined site. To do. Then, when an affected part such as cancer cells is found under the observation by the ultrasonic observation means, the puncture treatment tool 20 is inserted into the affected part in the body to perform high-frequency treatment such as high-frequency coagulation or high-frequency incision. To do.

The puncture treatment instrument 20 is inserted into the puncture treatment instrument insertion passage 11 of the ultrasonic endoscope in a state where the puncture member 22 is retracted into the guide tube 21. . However, during the inspection / diagnosis by the above-mentioned endoscope observation means or ultrasonic observation means, the insertion section 2
The tip hard portion 2c is held in a non-projecting state. When the affected area is found by the ultrasonic observation means, first, the puncture treatment device 20
The whole is made to project from the puncture treatment instrument insertion passage 11. As a result, the tip of the guide tube 21 comes into contact with the inner wall of the body, and when the grip portion 22c is pushed in from this state, the puncture member 22 slides in the guide tube 21 and moves forward, and the puncture needle portion. 22b is inserted into the body. By performing the puncturing operation of the puncture member 22 under the supervision of the ultrasonic observation means, the puncture member 22 can be punctured into the affected area reliably and safely.

When the high-frequency electrode 26 at the tip of the puncture member 22 is inserted into the affected area, it is stopped at that position and a high-frequency current is applied to the high-frequency electrode 26. Here, since the high frequency electrode 26 is in a sharp state, a current flows from the high frequency electrode 26, and the affected area can be coagulated or incised by the action of Joule heat generated at that time. In this way, it is possible to perform high-frequency treatment such as inserting the body cavity from the inner wall to a predetermined depth to high-frequency coagulate the affected part in the deep part of the body or perform high-frequency incision. It expands the range of procedures that can be performed using a mirror.
By using the high-frequency electrode 26 made of metal at the tip of the puncture needle portion 22b of the puncture member 22, the high-frequency electrode 26 has an X-ray contrast function, and the puncturing operation of the puncture member 22 is performed by X-ray. It is also possible to operate under the see-through of lines.

Next, FIG. 7 shows a second embodiment of the present invention, in which the puncture treatment instrument 40 is used.
Is similar to that of the first embodiment described above in that the puncture member 42 is inserted through the guide tube 41 made of an electrically insulating flexible tube. The puncture member 42 is formed by connecting a puncture needle portion 42b to the distal end of the flexible shaft portion 42a. The flexible shaft portion 42a and the puncture needle portion 42b are made of a member having electrical insulation. The high-frequency electrode 43 is integrally incorporated in the puncture member 42, and the needle-shaped electrode portion 43a protruding like a needle is exposed to the outside from a side surface portion in the vicinity of the puncture needle portion 42b. And
A cable 44 is connected to the high-frequency electrode 43. The cable 44 extends to the proximal end side of the flexible shaft portion 42a of the puncture member 42, and the high-frequency power source is provided as in the first embodiment. It is designed to be connected to.

According to this structure, the puncture member 42 of the puncture treatment instrument 40 is inserted into the affected part of the body, and a high-frequency current is passed through the high-frequency electrode 43 while the puncture member 42 is rotated. Member 42
It becomes possible to perform high-frequency treatment over a wide range on the periphery centered on.

Further, FIG. 8 shows a third embodiment of the present invention, in which the puncture treatment tool 50 in this embodiment is used.
Is composed of a guide tube 51 having electrical insulation properties and a puncture member 52 also having electrical insulation properties. The puncture member 52 has a puncture needle portion 52b sharply formed at the distal end of a hollow tube portion 52a. And a window 5 is provided in the vicinity of the connecting portion of the tube portion 52a to the puncture needle portion 52b.
3, the high frequency electrode 54 is provided in the window 53 so as to face the needle electrode portion 54a, and the cable 55 is inserted into the tube portion 52a. With this configuration, the high frequency treatment can be performed over a wide range as in the second embodiment described above.

FIG. 9 shows a fourth embodiment of the present invention. The puncture treatment tool 60 in this embodiment is composed of a guide tube 61 and a puncture member 62 as in the third embodiment shown in FIG. 8. The puncture member 62 is sharp at the tip of the tube portion 62a. A puncture needle portion 62b is continuously provided, and a window 63 is provided in a side surface portion near the puncture needle portion 62b. Therefore, the inside of the tube portion 62a is used as a suction passage, and therefore the high-frequency electrode 6 having the needle electrode portion 64a is used.
4 is fixed to the inner surface of the tube portion 62a, and a gap 65 exists between the high frequency electrode 64 and the window 63.
The passage inside the tube portion 62a communicates with the outside through the gap 65.

A grip portion 62c is provided at the proximal end of the tube portion 62a of the puncture member 62, and a cable 66 connected to the high frequency electrode 64 is provided in the tube portion 62a on the front side of the grip portion 62c. It is inserted and connected to a connecting pin 67 provided in the connecting portion 62d. Although not shown in the figure, a cord from a high frequency power source is connected to the connecting pin 67. Although substantially the same as that of the first embodiment, a suction connection portion 62e is further connected to the grip portion 62c. Then, the suction connection portion 62e is provided with a suction device 68 such as a syringe.
Is detachably connected.

According to this structure, when the puncture member 62 is inserted into the body, if the body fluid remains at the inserted site due to bleeding or the like, the body fluid is sucked by the aspirator 68.
By aspirating with, the high-frequency treatment can be performed so that the body tissue is surely brought into close contact with the high-frequency electrode 64. As a result, more efficient treatment is possible. Further, the vapor generated by performing the high frequency incision can be effectively collected by sucking the vapor. Of course, it is also possible to perform the treatment while rotating the puncture member 62 around the axis, whereby the treatment itself can be performed over a wide range.

Here, in order to enable suction, the structure shown in FIG. 10 can be used. That is, in the puncture treatment instrument 70 according to the fifth embodiment shown in FIG. 10, the tube portion 7 of the puncture member 72 inserted into the guide tube 71.
A window 7 opened near the continuous portion from 2a to the puncture needle portion 72b
Although the high frequency electrode 74 is attached to 3 to cover the window 73, the high frequency electrode 74 itself has a through hole 75 for suction. With this configuration, as in the fourth embodiment shown in FIG. 9, suction can be performed when the high frequency treatment is performed.

Next, FIG. 11 shows a puncture treatment tool 80 using a high-frequency knife. Also in this embodiment, the puncture treatment tool 80 includes a guide tube 81,
The tube portion 82a of the puncture member 82 is configured by a puncture member 82 including a tube portion 82a and a puncture needle portion 82b.
The window 83 is formed at the position of the continuous portion from the to the puncture needle portion 82b. An insertion passage 85 for the high frequency knife 84 is provided inside the tube portion 82a of the puncture member 82. As is well known, the high-frequency knife 84 has an insertion portion 86 formed by inserting a conductive wire 86b forming a needle-shaped high-frequency electrode into a sleeve 86a made of an insulating member,
The tip of the conductive wire 86b projects from the sleeve 86a by a predetermined length.

With this structure, when the puncture treatment instrument 80 is attached to the ultrasonic endoscope, the high-frequency knife 84 is stored inside the puncture member 82, and the puncture treatment instrument 80 is guided. It is stored in the tube 81. Then, in order to operate the high frequency knife 84, first, the entire puncture treatment instrument 80 is projected from the puncture treatment instrument insertion passage 11, and the guide tube 81 is brought into contact with the inner wall of the body cavity. In this state, the puncture member 82 is inserted to a predetermined position inside the body. In this state, the high frequency knife 84 is projected from the window 83 and the conductive wire 86b is energized,
Treatment such as cutting of the affected area can be performed. Also in the puncture treatment tool 80, the inside of the tube portion 82a of the puncture member 82 can be used as a suction passage.

Further, the puncture treatment instrument 90 shown in FIG.
As a puncture member 92 slidably inserted into the guide tube 91, the puncture needle portion 9 is attached to the tip of the tube portion 92a.
The puncture member 92 is provided with a conductive wire 93 that constitutes a linear high frequency electrode that constitutes a papillotomy knife. Puncturing member 92
Insertion holes 94a and 94b are formed in the portion near the tip and a position on the base end side thereof, and the conductive wire 93 is led out to the outside from the insertion hole 94a on the tip side of the puncture member 92. From the insertion hole 94b on the base end side to the tube portion 92a
Is inserted inside. The conductive wire 93 is connected to a high frequency power source at the base end of the puncture member 92. Therefore, while the puncture member 92 is inserted into the body, the conductive wire 93 is pushed and pulled while the conductive wire 93 is energized, so that the affected part can be cut.

[0029]

As described above, according to the present invention, a puncture member, which is slidably inserted into a guide tube and provided with a puncture needle which is inserted into the body at the tip, is attached to a part to be inserted into the body. Since the high-frequency electrode is provided, it is possible to reliably perform high-frequency treatment such as high-frequency coagulation or high-frequency incision on the affected area in the body.

[Brief description of drawings]

FIG. 1 is an overall configuration diagram of an ultrasonic endoscope to which a puncture treatment tool of the present invention is attached.

FIG. 2 is an external view showing the distal end surface of the distal end hard portion of the ultrasonic endoscope.

FIG. 3 is a side view of a hard tip portion of the ultrasonic endoscope.

FIG. 4 is a cross-sectional view of a puncture treatment tool showing a first embodiment of the present invention.

5 is an overall configuration diagram of a state in which the puncture treatment tool of FIG. 4 is attached to an ultrasonic endoscope.

FIG. 6 is an operation explanatory view showing a state in which the puncture treatment tool of FIG. 4 is subjected to ultrasonic treatment by an ultrasonic endoscope.

FIG. 7 is a cross-sectional view of essential parts of a puncture treatment tool showing a second embodiment of the present invention.

FIG. 8 is a cross-sectional view of essential parts of a puncture treatment tool showing a third embodiment of the present invention.

FIG. 9 is an overall configuration diagram of a puncture treatment tool showing a fourth embodiment of the present invention.

FIG. 10 is a cross-sectional view of essential parts of a puncture treatment tool showing a fifth embodiment of the present invention.

FIG. 11 is an overall configuration diagram of a puncture treatment tool showing a sixth embodiment of the present invention.

FIG. 12 is a cross-sectional view of essential parts of a puncture treatment tool showing a seventh embodiment of the present invention.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 Main body operation part 2 Insertion part 2c Tip hard part 11 Puncture tool insertion passage 20, 40, 50, 60, 70, 80, 90 Puncture treatment tool 21, 41, 51, 61, 71, 81, 91 Guide tube 22, 42 , 52, 62, 72, 82, 92 Puncture member 22a, 42a, 52a, 62a, 72a, 82a, 9
2a tube part 22b, 42b, 52b, 62b, 72b, 82b, 9
2b puncture needle part 23, 43, 54, 64, 74 high frequency electrode 24, 44, 55, 66 cable 26 high frequency power source 53, 63, 73, 83 window 84 high frequency knife 86 insertion part 86b, 93 conductive wire

Claims (6)

[Claims] 1. A puncture member, which is slidably inserted into a guide tube and has a puncture needle inserted into the body at its tip, is provided with a high-frequency electrode at the part inserted into the body. A puncture high-frequency treatment device. 2. The puncture needle of the puncture member is configured to have a high-frequency electrode at the tip thereof.
The puncture high-frequency treatment instrument described. 3. The puncture high-frequency treatment instrument according to claim 1, wherein a high-frequency electrode is provided at a position in the vicinity of the tip of the puncture member so that a part of the side surface is exposed. 4. The puncture high-frequency treatment instrument according to claim 1, wherein a window is provided on a side surface portion of the puncture member near a tip thereof, and a high-frequency electrode is attached to the window. 5. The puncture high-frequency treatment instrument according to claim 4, wherein a passage provided in the puncture member is opened in the window, and a suction device is connected to the passage. 6. The puncture high-frequency treatment instrument according to claim 4, wherein the high-frequency electrode is provided so as to be retractable from the window.